Online Risk Calculator Based on Remnant Cholesterol and Inflammatory Markers Can Predict Cardiovascular Mortality

Integrating an online risk calculator based on remnant cholesterol and inflammatory markers into the clinical workflow may help providers identify people at high risk for cardiovascular death and improve outcomes for their patients, according to a population-based study presented at the 75th Annual Scientific Session of the American College of Cardiology, in New Orleans.   

The remnant cholesterol-inflammatory index (RCII), a marker combining remnant cholesterol and high-sensitivity C-reactive protein (hs-CRP), is a strong predictor of increased all-cause and cardiovascular mortality, particularly in middle-aged and older adults. Elevated RCII signals combined lipid overload and chronic inflammation, and it may be used as a more accurate indicator of mortality risk compared to using remnant cholesterol or inflammation markers alone. 

Data collected from nearly 10,000 participants included in six 2-year cycles of the National Health and Nutrition Examination Survey (NHANES) were used to develop a risk score incorporating an RCII model, which was then evaluated for predictive performance. Follow-up information obtained from the National Death Index documented 2,100 deaths, including 555 cardiovascular-related deaths, over a median follow-up period of 14 years. 

The analysis showed that elevated RCII was a predictor of cardiovascular and all-cause mortality in U.S.-based adults. Compared with participants in the lowest quartile, those in the highest quartile had a 1.99-fold higher risk of cardiovascular-related death and a 1.52-fold higher risk of all-cause death. The risk score demonstrated strong discrimination, with 10-year area under the curve (AUC) of 0.920 for cardiovascular mortality and of 0.890 for all-cause mortality. The model also showed good calibration. 

“This study suggests that incorporating RCII assessments into clinical settings may facilitate early identification of cardiovascular death risk and improve prognosis in the general population,” the authors concluded. RCII-based risk calculators may be particularly useful for identifying individuals at high risk of cardiovascular events by tracking the combined effects of lipid metabolism disorders and systemic inflammation and could serve as a comprehensive tool for long-term risk stratification.